Publicity was silver lining on dark cloud of TB

AS AN infectious diseases specialist, I would like to thank the media and Andrew Speaker for the attention they brought to the growing problem of tuberculosis that is resistant to most of the antibiotics we use to treat it.

Speaker is the Atlanta attorney who gained worldwide media attention last month when he traveled on an international commercial flight with a rare form of drug-resistant tuberculosis. Speaker and his fiancee had flown to Europe to get married, despite warnings from health officials not to travel.

Tuberculosis takes the lives of more than 1.5 million people each year. It is a pathogen that preys on those who can least afford it -- the undernourished, the crowded, the poor and those with immune deficiencies. It is also a paradox in medicine and public health in that every individual can be cured with the right resources and expertise -- yet the economic, political and available resource barriers are so great that it appears to be spreading rather than being eradicated. The consequence is that Mycobacterium tuberculosis strains persist and mutate into increasingly resistant strains to survive in response to the inadequate therapies that are available to some. These organisms are survivors -- they were here long before man and likely will be here long after.

The death of Mimi in Puccini's famous opera "La Boheme" was an early attempt to bring to light the public and personal impact of phthisis, a common-place scourge of society before the scientific revolution brought effective antimicrobials to the marketplace -- but only within my lifetime. Society and industry have invested heavily in research since then and embarked upon public health efforts to control this pathogen and prevent its spread. Although there has been progress, we seem to be failing on a global scale and we now see the organism progressively learn ways to thwart or destroy the antibiotics that were once miraculous in their effects.

The recent awareness of Multi-Drug Resistant TB (MDR-TB) and now the discovery of Extensively (or Extremely) Drug Resistant TB (XDR-TB) has, in many respects, been ignored by funding sources and the public, despite the risks.

The convoluted and dramatic adventures of Speaker and the responses of authorities are a novel in the making and fruit for many further articles and reports. They also have brought the problems and risks of MDR-TB to a level of public awareness beyond dreams of public health authorities such as the Centers for Disease Control and the World Health Organization -- and with minimal expense compared to the millions of dollars being expended on formal programs for education and infection control.

I thank you, Andrew and the media, for bringing XDR-TB to our attention. Let's hope the consequences will lead to a quantum leap in funding for research and infection control and availability of medical resources to treat this dread disease.

Alan D Tice, M.D., is an infectious disease specialist with the John A. Burns School of Medicine at the University of Hawaii. alantice@idlinks.com